The Rand Corporation recently published a study of determinants of physician professional satisfaction, and their implications for patient care. One of the “most novel and important findings” related to electronic health records (EHRs).
The study found that EHRs affected physician satisfaction both positively and negatively. Physicians like the idea of EHRs, and appreciate their “promise” to improve patient care and thus professional satisfaction. However, the current reality of EHRs significantly detracted from physician satisfaction for multiple reasons,including, “Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation.”
I can personally testify to the validity of these findings. I have had the opportunity as a family practice doc to work extensively with two EHR systems. One is considered the “Cadillac” of EHRs, and the reputation fits: a bloated, lumbering, energy-guzzling EHR with lots of bells and whistles and a hefty price tag. The other one—well, let’s just say that using it, one gets the impression that the programmers made sure there were no physicians within 100 miles of them who might contaminate their EHR design with concepts of how actual physicians function.
Both of these EHRs are certified for something called “Meaningful Use.” This is a set of practices that EHRs must be capable of, and physician offices and hospitals have to implement, in order to receive bonus payments from the federal government and avoid penalties. The practices include things like E-prescribing, providing patients with an electronic copy of their health information, and generating patient lists for specific conditions.
But some things are absent from the requirements for Meaningful Use, like usability, and doesn’t detract from patient-physician interactions. A new report documents what most doctors already feel: that increased use of EHRs means less face-time with patients. For many if not most physicians, it means lots of time gazing into a screen and keyboarding that used to be spent face-to-face with patients. We spend time tending charts that used to be spent tending patients. I can confidently assert that most doctors did not go into the clinical practice of medicine because they prefer data-entry over relationships with patients; but this is what the current generation of EHRs has handed us.
The federal government defines “Meaningful Use” as “Use of EHRs in a way that positively affects patient care.” Positive effects on patient care can (theoretically, at least) come about by the data storage and manipulation capabilities that computers offer. But if they come about at the expense of that which is central to every human relationship—looking into the other’s face, body language that says, “What you are expressing to me is so important that I will give you my complete attention,” not multitasking—then perhaps the negative effects have overbalanced any theoretical positive effects. One of the dangers of EHRs is the old “To a patient with a hammer, everything looks like a nail” conundrum; to a person with a computer, everything looks like data. When we define “Quality medical care” solely in terms of what we can count and measure, when we value data over relationship, then “Meaningful Use” becomes a meaningless slogan.